What access intimacy is and how some therapists are incorporating it in their practice to make it inclusive of queer and disabled people.
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“I don't need to hide behind my profession. I can own my disabled and queer identities while being a psychotherapist,” said 33-year-old Anindita, who is based in Bengaluru. They began practising therapy in 2013. "Queerness and disability were rarely a part of conversations about therapy back then," said Anindita. "There were no certifications to become a queer affirmative therapist–a process now accessible to therapists."
Today, Anindita is one of the few therapists in India who openly talks about living with endometriosis (a chronic condition that causes extremely painful periods and other symptoms associated with it), Attention Deficit Hyperactivity Disorder (ADHD) and autism. They were initially conflicted about expressing what living with these conditions looked and felt like.
Then in 2020, while talking about their own challenges with endometriosis on social media, they were contacted by several disabled and chronically ill people who echoed Anindita’s experience. This exchange empowered Anindita to open up about their needs associated with endometriosis not just in their personal but also in therapy space. Anindita started communicating their need that they might have to reschedule sessions during pain flare-ups. Anindita’s clients not only understood them but also felt encouraged to communicate their own needs to Anindita. Over time, Anindita and their clients began sharing Access Intimacy, in which they understood each others’ certain specific needs without a lot of explicit communication.
The phrase ‘access intimacy’ was coined by Mia Mingus, a queer disabled writer and educator, on her blog Leaving Evidence. She illustrates it as an “elusive, hard to describe feeling when someone else gets your access needs.”
An ‘access need’ refers to something that enables a person to function and fully engage in their social environments. It is important to distinguish that an access need is different from a general need. The former is a need necessitated because of a certain barrier or inaccessibility; like needing subtitles while watching a movie or wheelchair access at a Pride march.
When someone understands and supports these needs in a way that eases a person from the labour of having to explain or justify their needs, and they try to create suitable environments to have these needs met, it creates ‘access intimacy’ between them. Think: a friend preemptively downloading subtitles before your arrival during movie night, or a partner checking with the city’s Pride march organisers about wheelchair accommodation. Access intimacy can be spontaneous like with a new friend you just “click with”, or it may be cultivated over time.
Like a lot of autistic persons, Anindita sometimes prefers or needs to be non-verbal, particularly when they are trying to manage overstimulation. “It’s an access need that my partner often meets,” they said. “He knows I’m not being cold. I just need to not speak for some time. And we sit together in silence. That’s what access intimacy is for me–that you are understanding of my needs even when I may not have the capacity to state them in words.”
In the therapy room, Anindita holds slots on the calendar for some clients with autism since having a fixed routine is an access need for them. For a non-verbal autistic client, Anindita conducts sessions primarily on chat. They also accommodate flexible scheduling for some terminally ill clients whose health needs are challenging and unpredictable.
In 2021, Anindita started publicly identifying themselves as a therapist who is disabled in addition to being queer. They said, “Because people in my life affirmed my queerness, it was easier to accept it than the fact that I was a person with disabilities. This is because, socially, disabled bodies and disabled experiences are not really talked about.”
But now, their therapy contract openly states: “I identify as non-binary and my preferred pronouns are they/them. I am also neurodivergent (ND) and live with endometriosis––so there might be times when I have to reschedule or cancel a session due to pain flare-ups.”
In their book, Care Work: Dreaming Disability Justice, disability activist Leah Lakshmi Piepzna-Samarasinha, characterises access intimacy as a “process and learnable skill that can be developed by disabled and abled individuals alike through asking and respecting disabled knowledge.”
However, because our social systems are often designed to ignore and invisibilise the needs of queer and disabled people, our access needs are generally recognised better by those who share similar struggles. Mia writes, “Instantly, we can hold the weight, emotion, logistics, isolation, trauma, fear, anxiety and pain of access.”
Consider this: for a trans person with chronic pain, wearing restrictive clothing can be quite uncomfortable. So they may prefer chest binders and pants with stretchable materials. It would take more effort for them to explain all this to a person who doesn’t share similar struggles, but a person who does, is likely to understand their need relatively easily.
Anindita said they now share access intimacy with clients who have common lived experiences. But it was not always like this. Earlier in their practice and in everyday life, Anindita was used to masking, that is, suppressing their thoughts, emotions, behaviours, and facial expressions to meet neurotypical or “normal” standards.
With little to no mainstream conversations on mental health professionals with disabilities to refer to, Anindita found themselves consumed by shame for “not being like other therapists” in such situations. Anindita said they carried their childhood embarrassment of growing up as “the sick child of the house” into the therapy room. They worried their clients would be upset at them for not being consistent.
They often felt they “didn’t belong” in many spaces in the life they lived before they affirmed their identity. But over time, the vulnerability with which their clients spoke to them about their own struggles and challenges, helped Anindita feel “seen and safe as a disabled, queer person.”
“I don't need to hide behind my profession. I can own my disabled and queer identities while being a psychotherapist,” said 33-year-old Anindita, who is based in Bengaluru. They began practising therapy in 2013. "Queerness and disability were rarely a part of conversations about therapy back then," said Anindita. "There were no certifications to become a queer affirmative therapist–a process now accessible to therapists."
Today, Anindita is one of the few therapists in India who openly talks about living with endometriosis (a chronic condition that causes extremely painful periods and other symptoms associated with it), Attention Deficit Hyperactivity Disorder (ADHD) and autism. They were initially conflicted about expressing what living with these conditions looked and felt like.
Then in 2020, while talking about their own challenges with endometriosis on social media, they were contacted by several disabled and chronically ill people who echoed Anindita’s experience. This exchange empowered Anindita to open up about their needs associated with endometriosis not just in their personal but also in therapy space. Anindita started communicating their need that they might have to reschedule sessions during pain flare-ups. Anindita’s clients not only understood them but also felt encouraged to communicate their own needs to Anindita. Over time, Anindita and their clients began sharing Access Intimacy, in which they understood each others’ certain specific needs without a lot of explicit communication.
The phrase ‘access intimacy’ was coined by Mia Mingus, a queer disabled writer and educator, on her blog Leaving Evidence. She illustrates it as an “elusive, hard to describe feeling when someone else gets your access needs.”
An ‘access need’ refers to something that enables a person to function and fully engage in their social environments. It is important to distinguish that an access need is different from a general need. The former is a need necessitated because of a certain barrier or inaccessibility; like needing subtitles while watching a movie or wheelchair access at a Pride march.
When someone understands and supports these needs in a way that eases a person from the labour of having to explain or justify their needs, and they try to create suitable environments to have these needs met, it creates ‘access intimacy’ between them. Think: a friend preemptively downloading subtitles before your arrival during movie night, or a partner checking with the city’s Pride march organisers about wheelchair accommodation. Access intimacy can be spontaneous like with a new friend you just “click with”, or it may be cultivated over time.
Like a lot of autistic persons, Anindita sometimes prefers or needs to be non-verbal, particularly when they are trying to manage overstimulation. “It’s an access need that my partner often meets,” they said. “He knows I’m not being cold. I just need to not speak for some time. And we sit together in silence. That’s what access intimacy is for me–that you are understanding of my needs even when I may not have the capacity to state them in words.”
In the therapy room, Anindita holds slots on the calendar for some clients with autism since having a fixed routine is an access need for them. For a non-verbal autistic client, Anindita conducts sessions primarily on chat. They also accommodate flexible scheduling for some terminally ill clients whose health needs are challenging and unpredictable.
In 2021, Anindita started publicly identifying themselves as a therapist who is disabled in addition to being queer. They said, “Because people in my life affirmed my queerness, it was easier to accept it than the fact that I was a person with disabilities. This is because, socially, disabled bodies and disabled experiences are not really talked about.”
But now, their therapy contract openly states: “I identify as non-binary and my preferred pronouns are they/them. I am also neurodivergent (ND) and live with endometriosis––so there might be times when I have to reschedule or cancel a session due to pain flare-ups.”
In their book, Care Work: Dreaming Disability Justice, disability activist Leah Lakshmi Piepzna-Samarasinha, characterises access intimacy as a “process and learnable skill that can be developed by disabled and abled individuals alike through asking and respecting disabled knowledge.”
However, because our social systems are often designed to ignore and invisibilise the needs of queer and disabled people, our access needs are generally recognised better by those who share similar struggles. Mia writes, “Instantly, we can hold the weight, emotion, logistics, isolation, trauma, fear, anxiety and pain of access.”
Consider this: for a trans person with chronic pain, wearing restrictive clothing can be quite uncomfortable. So they may prefer chest binders and pants with stretchable materials. It would take more effort for them to explain all this to a person who doesn’t share similar struggles, but a person who does, is likely to understand their need relatively easily.
Anindita said they now share access intimacy with clients who have common lived experiences. But it was not always like this. Earlier in their practice and in everyday life, Anindita was used to masking, that is, suppressing their thoughts, emotions, behaviours, and facial expressions to meet neurotypical or “normal” standards.
With little to no mainstream conversations on mental health professionals with disabilities to refer to, Anindita found themselves consumed by shame for “not being like other therapists” in such situations. Anindita said they carried their childhood embarrassment of growing up as “the sick child of the house” into the therapy room. They worried their clients would be upset at them for not being consistent.
They often felt they “didn’t belong” in many spaces in the life they lived before they affirmed their identity. But over time, the vulnerability with which their clients spoke to them about their own struggles and challenges, helped Anindita feel “seen and safe as a disabled, queer person.”
While different disabled queer clients may have different access needs, the first step to being an affirmative therapist, according to Anindita, is to actively invest efforts into understanding how to engage with a client’s various identities. “If you have a client with cerebral palsy (CP) , study CP in-depth, beyond general understanding. You cannot expect your client to do the work,” Anindita said. “They can share their particular experience of living with the disability, but they should not have to teach you what it is.”
Following this understanding, Anindita sends their clients with ADHD, who often experience time blindness ( a cognitive disability to manage and perceive time) reminders twenty-four hours, two hours and one hour prior to their upcoming session. Anindita said,“I don't make it a very big deal if they come in late because I know time blindness is a big part of living with ADHD.”
“As a disabled person you already feel a lot of shame about not showing up in the world as an ableist society expects you to. I want therapy to be the last place where they feel that way.”
While this may sound like basic homework in therapeutic practice, often, therapists take on clients from various backgrounds believing that being non-judgemental and genuine are enough. But when a therapist isn’t well-informed about the identities their client occupies, it may border on erasure of these identities. Explaining oneself over and over again may end up making their client feel pitied and misunderstood. While some spaces like Mariwala Health Initiative and Narrative Practices India are offering training for therapists to better equip themselves about queerness, disability, caste and minority identities, there isn’t sufficient data to tell if it is a common practice for therapists to enrol themselves in such opportunities.
Like Anindita, Sahana, a 25-year-old neurodivergent and queer therapist with ADHD in Bengaluru, underscores the value of understanding neurodivergent clients with a neuro-affirmative approach. Sahana is also the founder of a peer circle for people exploring ADHD. Sahana’s name has been changed in this story to protect their identity.
She said, “For a neurotypical person, it might be simpler to say, ‘Okay I want to build this habit and from tomorrow onwards, at X time I'm going to set an alarm and I'm going to start working on it.’ But for a lot of neurodivergent people, that's where the challenge is–getting started.”
Sahana’s work through her peer circle and in therapy is aimed at enabling disabled and queer clients to speak up for themselves, as well as connecting them with community resources.
Anindita points out that disclosing their identities to their clients in therapy goes against what therapist training teaches them. “The therapy training revolves around you not bringing yourself to the therapy space at all. That has never made sense to me.”
But some therapists, Like Pooja Nair, see value in not disclosing their identities to their clients. Pooja is a 39-year-old queer disabled consultant mental health professional and faculty at Mariwala Health Initiative (MHI)’s Queer Affirmative Counselling Practice in Mumbai. She said,“There are two reasons for this. One is for ensuring my own boundaries and confidentiality. Two, I believe that because of the therapist-client power dynamic, my own concerns might overtake those of the clients.”
As a client herself, Pooja considers therapy to be a part of assisted living that she requires as a disabled person. Her own therapist of 10 years has not disclosed a lot about her identity, but she still has been able to share access intimacy with Pooja.
With the help of her therapist, Pooja has been able to build a strong support system of relationships, working around any limitations in energy caused by her disability. Her therapist’s focus on Pooja’s access needs has enabled her to build access intimacy with those closest to her and learn how to communicate her access needs.
While Pooja avoids bringing up her own identities during sessions with her clients, she ropes in her disabled and queer identities as a facilitator in mental health professional training. “If I'm teaching a course, it becomes part of the pedagogy to explain concepts drawing from my lived experiences, in addition to theoretical perspectives,” she said. Pooja recommends including concepts like access intimacy in therapist training, and as a goal to achieve in therapy with clients.
This reinforces what Christina Lee, a researcher at King’s College London points out in her paper Cripping the Medical Humanities: In the mental health field, research that fails to consult disabled professionals reinforces ableist standards of health, and exacerbates the power imbalance between professionals who are able-bodied and those who are disabled.
Desiree Valentine, an assistant professor of philosophy at Marquette University, writes in her paper Shifting the Weight of Inaccessibility about how “access intimacy urges us to direct our attention to the deficiencies of an ableist world rather than the supposed deficiencies within individual bodies that must be corrected.”
In the same vein, Sahana –who had not come across the term access intimacy when I spoke to her for this story– maintains that while individual psychotherapy is an important resource, “a lot of mainstream therapy just pathologises us, puts us into boxes.” She suggests that building peer communities of disabled queer persons can be a strong form of resistance against the dominant discourses.
Bengaluru based, 29-year-old queer illustrator Sonaksha, who is also disabled, chronically ill, and fat, suggested that having more disabled and non-disabled people learning about access intimacy outside of therapy spaces would help those spaces become inclusive. Giving an example, Sonaksha said, “If I'm working at an event and half way through I feel overstimulated, it would be reassuring to know that I can walk out, take a break, and not offend someone who's part of the organising committee.”
They added, “I think most of us with chronic illnesses spend a lot of time pushing ourselves–climbing stairs when your knees are giving way, or pushing yourself to meet someone because you feel bad about consecutively cancelling on them.”
For Sonaksha, a lot of it ties into the immense fear of being isolated for having these needs met. Often, disabled people have limited energy for socialising after the daily maintenance that goes into living with a disability, and having to engage in environments that are not accommodative. As a consequence, even casual social engagements like catching up with a close one can often get postponed for weeks and months. And a common worry that comes up in disability circles is wondering if one will be able to sustain any friendships at all with non-disabled people in their lives. So it feels really important to have a space - like in therapy - where they feel safe enough to expect a level of access.
Sonaksha often depicts access intimacy in their art. “A lot of the characters in my work are leaning on each other, or they're on beds and resting. I like to create a world that looks like the ones my queer disabled kin occupy.” Sonaksha has also illustrated a self-learning manual with Rising Flame for mental health care providers, which breaks down disabled vocabulary like access intimacy and ableism. Disabled-led resources like this are valuable in building the knowledge on access intimacy.
As Mia Mingus writes, “by calling on able-bodied people to inhabit our world, rather than fitting disabled people into an abled world,” access intimacy promotes interdependent relationships of care, where we tend to each other despite our differences.
This story was produced in collaboration with Revival Disability India.
Anna Maria (she/her) is a queer and disabled psychologist and writer based in Bangalore. She strives to explore the bodymind in a way that is people-first, anti-ableist, and queer affirmative.
Shruti Sunderraman (she/her) is a journalist, writer, editor and strategist who splits her time between Bombay and Bangalore. She’s worked in culture, health, gender and science across publications over the last 10 years.
Jose (she/they) is a non-binary illustrator from Kerala whose work highlights personal stories marked by gender, body experiences and their south-Indian heritage. While not lost in their sketchbook, they can be found devouring all things camp and horror.
Producer
Ankur Paliwal (he/they) is a queer journalist, and founder and managing editor of queerbeat.
